DIAGNOSIS VERSUS TREATMENT

A special procedure can be defined as a radiographic method of demonstrating certain anatomic features that lack natural contrast with surrounding structures by the instillation of a substance to produce structural contrast. This definition encompasses all contrast studies done today. Most of these procedures are considered routine and can be performed without specialized radiographic equipment.

Modern diagnostic and interventional procedures have been segmented into two areas, cardiac and vascular. Each area is broken down into diagnostic and therapeutic (interventional) studies. Diagnostic procedures, as their name implies, are performed to identify a particular pathologic process. These procedures are also used to localize certain vessels or tumors prior to the performance of therapeutic procedures. When the object of the procedure is related to the vascular system the general term angiography is used. If the subject vessel is an artery, the study is called an arteriogram. Venography refers to advanced studies of the venous system.

Interventional procedures are performed to treat the pathologic process. The American Registry of Radiologic Technology (AART) (www.ARRT.org) has segmented this specialty into those studies considered to be vascular interventions and those pertaining to the heart (cardiac interventions). Each of these subdivisions encompasses different techniques, equipment, and knowledge and can be considered as separate and distinct disciplines.

ADVANCED PROCEDURE ROOM AND SUITE DESIGN

Interventional radiology is a complex specialty providing minimally invasive treatments for a wide variety of vascular and cardiac diseases. As the techniques become more complex, the equipment required also becomes specialized, and consideration must be given to the design of the special studies suite and the specialized equipment required for the procedures.

In addition to specialized equipment, these advanced procedures require a highly specialized team of individuals to execute the techniques required to successfully obtain the most accurate diagnostic information and to provide an intervention, if necessary. The radiographer is an integral part of this team and is responsible for understanding some basic pharmacology, the operation of the equipment, making the preparations for the procedure, monitoring the patient, and assisting the physician during the examination.

Modern advanced diagnostic and interventional procedures require a special room (or rooms) equipped to perform these examinations. The room or suite is generally dedicated to the performance of these advanced procedures, and its size, location, and construction should be given special consideration when this area is planned. The advanced level radiographer will not always have a role in planning the construction and design of the special procedures suite, but it is helpful to have a basic understanding of the requirements for a dedicated suite.

Unlike the routine diagnostic radiographic room, the advanced procedure suite must serve various purposes. The procedure room must be designed so that it can be used for minor surgery as well as for the advanced diagnostic procedures that will be performed. Standard equipment such as cardiac monitoring devices, emergency supplies, and certain specialty measurement instruments should also be available.

The numbers of advanced studies have increased in recent years. Generally speaking these studies encompass nonvascular, vascular, and cardiac procedures. A larger number of diagnoses are being performed utilizing magnetic resonance imaging and computed tomography, which is less invasive than diagnostic angiography. That being said, diagnostic angiography is still performed on a routine basis. Some design differences in the vascular and cardiac suites are required to accommodate the different types of procedures.

Before discussing equipment, consideration should be given to the planning or layout of the advanced procedure suite. In addition to a team of personnel, a wide variety of specialized equipment is necessary for diagnostic and interventional radiography. At times, the procedures may pose a risk to the patient, and severe, if not fatal, reactions may occur. These considerations require a room that is considerably larger than a routine radiographic room. The room should be a minimum of 400 ft² (37.16 m²); more complex advanced radiographic rooms can approach 600 ft² (55.74 m²). (This does not take into consideration the control, monitoring, preparation, and dressing rooms.

The control room must be larger than a simple control booth found in routine radiographic rooms. The additional space is required to accommodate the specialized equipment. The control room should be adjacent to or in the special procedure suite and should be designed to permit an unobstructed view of the entire suite. Protection from radiation hazards is mandatory, yet rapid access to the suite in emergency situations must be assured. In general, the special procedure control room should be a minimum of 100 to 150 ft² to provide ample room for the placement and operation of the equipment. In the cardiac catheterization suites, the control room should be large enough to house the equipment required for cardiac monitoring and testing. The amount and type of monitoring equipment available to the institution ultimately determines the actual size of the control area. An unobstructed view of the radiographic room and free communication with the other major areas in the advanced procedure suite are also necessary design requirements.

The preparation (prep) room is an important addition to the special procedure suite providing necessary storage space for the smaller pieces of equipment that are essential to the examinations. The prep room can also be designed and equipped to function as a scrub room, if necessary. In larger teaching and research institutions, the prep room should contain a work area that may be used for making the catheters required during the procedure. Although this is not common practice in most institutions, it is still practiced when newer procedures or techniques are developed.

Smaller hospitals use disposable catheters almost exclusively, which diminishes the importance of this area. If nondisposable tools and equipment are used, the prep area should have facilities for cleaning this equipment adequately after the procedure before it is repackaged for sterilization. In summary, the prep room should provide ample work space to allow the technologist to prepare and clean the equipment before and after the procedure.

If a large number of special procedures are done on an outpatient basis, dressing and waiting rooms should be provided adjacent to the suite for the comfort and convenience of the patient. A consultation area should also be provided to allow for the patient and the family to privately discuss the specifics of the procedure with the physician. Figures 1-1 and 1-2 illustrate some possible special procedure suite layouts for vascular and cardiac catheterization procedures.

INTERVENTIONAL RADIOGRAPHY ROOM AND SUITE DESIGN

The need for a dedicated interventional radiography room is determined by the numbers and types of procedures performed. Vascular interventional procedures are usually performed in the general special procedure suite. The design and equipment make it ideal for use during diagnostic angiography as well as for interventional radiographic procedures.

Nonvascular interventional studies may also be performed in the angiography suite, but the room design is usually too sophisticated for this type of radiography, which does not require the elaborate recording equipment necessary for vascular studies. The nonvascular interventional procedures need a slightly more sophisticated room design than is provided by a general fluoroscopic room.

As the number of interventional examinations increases, especially in the larger hospitals, dedicated interventional radiography rooms will become necessary to prevent the disruption of the normal work flow in either a special-purpose fluoroscopic room or a special procedure suite. The design of the interventional radiography room is very similar to that of the advanced procedure suite discussed previously. Vascular interventional procedures can be performed in the angiography suite, and unless the number of these procedures interferes with the normal work flow of these rooms, a dedicated room will not be necessary. The nonvascular interventional room will require some modification of the basic special procedure room design.

Basic interventional radiography room design considerations may be summarized as follows:

The interventional radiography room should be close to the special procedure area as well as to the ultrasonography and computed tomography (CT) rooms. Room size should be comparable to that of the basic angiography suite, a minimum of 400 to 600 ft² (37.16 to 55.74 m²). Doorways should be at least 4 ft (1.2 m) wide to accommodate stretchers, beds, and any extra-wide equipment that may be necessary.

Adjacent to the interventional suite should be a patient holding and monitoring area that will be used to hold patients before and after the procedure as well as to house any preprocedural or postprocedural monitoring equipment. The room should comfortably allow for a minimum of two isolated stretchers or beds. An appropriate room size is about 100 ft² (9.29 m²). It should be equipped with a centralized supply of oxygen and vital sign monitors.

The control room area is equal in size and capacity to that used for general angiography, affording the occupants optimum viewing of the procedure as well as maximum radiation protection.

Ideally, a laboratory and workroom should be part of the interventional suite. The size of this room will depend on the type of equipment used. Space should be provided for a laboratory table with facilities to process cytologic samples obtained by needle aspiration or brush biopsy. This area can also be used as a viewing room, storage center, and scrub room, if size and design permit.

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